RCT

PREVENT

Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults

NEJM, 2019 · Multicenter randomized trial in 7 ICUs (n=401)

Clinical question

Does gentle bag-mask ventilation during the interval between induction and laryngoscopy reduce hypoxemia during RSI in the ICU?

Population: Critically ill adults undergoing emergency tracheal intubation
Intervention: Gentle bag-mask ventilation (BMV with PEEP valve) during the apneic period
Comparator: No ventilation (apneic oxygenation alone)
Primary outcome: Lowest arterial oxygen saturation (nadir SpO2) between induction and 2 min post-intubation
Result: Lowest SpO2 was significantly higher in the BMV group (median 96% vs 93%, P=0.01). Severe hypoxemia (SpO2 < 80%) occurred in 10.9% vs 22.8% (P<0.001). Aspiration rates did not increase (2.5% vs 4.0%).

What the trial found

Gentle BMV during RSI significantly reduced profound peri-intubation hypoxemia without increasing pulmonary aspiration.

Current guideline position

Recommended in SCCM and airway guidelines.

Clinical interpretation

Changed ICU RSI practice: gentle bagging with low pressure/PEEP is now routinely performed during the apneic phase.

Clinical Context & Relevant Topics (1)

Disease Reference

Airway Management & Rapid Sequence Intubation

The 7 Ps of ICU intubation, the physiologically difficult airway, BOUGIE/DEVICE video laryngoscopy trials, hemodynamic optimization, waveform capnography, and scalpel-bougie cricothyroidotomy.

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